Policy & Regulation News

Meaningful Use Overhaul Welcomed Change for Hospitals

“In particular, the MU program has diverted clinician, staff, and other resources away from activities with greater patient benefit and has forced technology to develop in a way that limits innovation."

January 14, 2016 - In response to the Center for Medicare & Medicaid’s recent announcement regarding upcoming changes to the EHR meaningful use programs, 31 healthcare organizations signed a letter reminding Department of Health & Human Services’ Secretary Sylvia M. Burwell of the specific concerns and needs regarding the program.

The letter, which was posted on the popular blog of Beth Israel Deaconess’ CIO John Halamka, MD, acknowledges the part meaningful use has played in spurring widespread EHR adoption, but states that significant change is needed in order for these programs to remain effective. Any meaningful use modifications should not be seen as a cure-all, the signatories warn, and industry leaders must remember some of the fundamental EHR needs of the healthcare industry.

Thus, in light of the recent promise of significant meaningful use reforms, the letter outlines the specific concerns the 31 signed organizations have with the meaningful use program.

First, the letter explains how the format of the meaningful use programs have kept providers from being able to work directly with patients, stating that the prescriptive approach of the program was not workable with provider needs.

“In particular, the MU program has diverted clinician, staff, and other resources away from activities with greater patient benefit and has forced technology to develop in a way that limits innovation,” the signatories wrote.

Although the meaningful use modifications rule which was released this past October made headway in reducing program requirements, the signatories explain that these modifications cannot be seen as the cure-all for the program. Instead, serious program changes are necessary.

For example, the letter states that Stage 3 meaningful use needs to be delayed. Providers have frequently voiced their opinions against the format of Stage 2 and have proven that it is very difficult to attest to this stage of the program. However, the signatories explain that Stage 3 takes a very similar format, and sets providers up for the same difficulties they had during Stage 2.

Therefore, in addition to a delay in program implementation, the signatories believe Stage 3 needs a complete requirements overhaul.

“The Stage 3 final rule, like its predecessor rules, is too focused on pass-fail requirements and lacks emphasis on outcomes,” the letter reads. “By maintaining this flawed structure, we do not believe Stage 3 will support movement towards more innovative care models or encourage continued participation.”

Additionally, the signatories state that meaningful use needs to better support the whole industry push for increased interoperability. Under the current program requirements, meaningful use does not set up the groundwork for better interoperability, and does not necessarily encourage better data sharing.

Stage 3 also fails to prioritize foundational issues to improve interoperability, which is imperative for our medical communities to function at their highest levels,” the signatories wrote. “By using MU as an enforcement tool, there has been little improvement in data exchange. Many in our communities are facing excessive costs to purchase EHR interfaces and upgrades, which only support limited interoperability.”

Additionally, the format of data that does get exchanged is not workable for physician needs. Meaningful use requirements block interoperability progress that would alleviate those challenges.

“Patient medical information is also shoehorned into a format that was designed for MU measures, and not in a way that accommodates the needs of physicians and patients,” the letter explains. “Addressing these issues must be a priority, but what is required in the Stage 3 rule limits progress while diverting needed resources.”

The letter concludes by asserting that the meaningful use programs have also limited EHR innovation. Because EHR vendors have been designing their software to adhere to the one-size-fits-all measures of meaningful use, they have not been able to improve their systems to better serve individual, unique provider needs.

“Lastly, the MU program has been the driving factor behind the design of EHR technology,” the letter concludes. “Health IT vendors routinely state that meeting MU requirements monopolizes most of their development and testing time and that many of the upgrades or features most requested by their customers are put on the backburner until the complex process of certifying for MU takes place.”

Several of the concerns listed in this letter were addressed earlier this week by CMS acting administrator Andy Slavitt in an address at the JP Morgan Healthcare Conference. According to Slavitt, the meaningful use program has the industry has known it will no longer exist. CMS will replace the requirements with a program that rewards physicians for successful outcomes-based measures.

CMS hopes these changes will put more power back into provider hands. Additionally, CMS will ideally function more of a facilitator of physician needs rather than the entity which dictates what providers do. This could in turn potentially improve patient care and create better health outcomes.

“Our role is actually much more minor,” Slavitt maintained. “Our role is simply to say, ‘for the things that you want to accomplish, if you accomplish them on behalf of our beneficiaries, you ought to get rewarded.’ So we’re not the driver; we really are there to reinforce the things physicians should want to do.”

If these potential changes come to fruition, several of the concerns listed in the above-mentioned letter could be addressed and alleviated by CMS.